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Application Form to rent a Garage Plot in Northwich area Title: ______________ Forename(s): ____________________________ Surname: ____________________________ DOB: ______________ National Insurance No: ______________ Telephone No: ______________ Current Address: Postcode: Mobile Phone No: _____________ _________________________________ _________________________________ _________________________________ _________________________________ Is your current home address rented from Weaver Vale Housing? Yes/No If yes, please provide the tenancy reference number: ______________ Do you already rent a garage/garage plot from Weaver Vale Housing? Yes/No If yes, please provide the address, service area, & tenancy reference number: __________________________________________________________________ __________________________________________________________________ If you are not currently renting a garage or a property from Weaver Vale have you ever rented a garage, garage plot or a property from Weaver Vale Housing? Yes/No If yes, please provide the address or addresses below: _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ Have you ever been offered (but refused) a WVHT tenancy before? Yes/No Are you a Board Member/employee of Weaver Vale Housing Trust? Yes/No Are you related to a Board Member/employee of Weaver Vale Housing Trust? Yes/No If yes, give details Do you own a car? Yes/No Signature: Date: ______________ Office Use Only Inputted onto QL by ___________________ Date: ____________ Application Number Generated: ________________ We want to be more accessible and as a result we are asking you to tell us how we can tailor our service to your needs. This will include, sending all future communications to you in the language or format you prefer. To help us do this and ensure that we deliver the most appropriate service, please take a few moments to complete the following questions: Primary Tenant Date of Birth Mobile no: Home Tel no: E-mail address Communication Is English your preferred language for communication? YES NO If ‘NO’ what language would you like us to use? ---------------------------------Do you prefer to receive communications in another form? Braille Tape CD Large Type Disability Do you have a disability? YES NO If ‘Yes’ what disabilities do you have? (Please specify in associated box provided) Hearing Impaired Mobility Impaired Visually Impaired Other (please specify) Does anyone else in your household have a disability? YES NO If ‘Yes’ what disabilities do you have? (Please specify in associated box provided) Hearing Impaired Mobility Impaired Visually Impaired Other (please specify) Ethnicity White British Irish Chinese Bangladeshi White Asian Other Ethnic background Age 16 – 24 25 – 49 Black British African Indian White/ Black Caribbean Other White background Other Mixed background 50+ Asian British Caribbean Pakistani White/ Black African Other Black background Other Asian background Areas of choice - please indicate preferred areas with a tick BARNTON Townfield Lane ANDERTON Old Road LEFTWICH NETHER PEOVER Swan Grove Balmoral Avenue Dunham Road Woodside Terrace LOSTOCK GRALAM Townshend Road Wilson Crescent WINCHAM Birch Grove Pickmere Lane DAVENHAM Mount Pleasant Road WEAVERHAM Keepers Lane Briar Lane Cherry Lane Elm Road Farm Road Gleave Road Poplar Road Walnut Avenue RUDHEATH Belmont Road Bowden Drive Comboy Drive St Johns Close Laburnum Road CUDDINGTON Ash Road Fir Lane WHITLEY Raddel Lane DATA PROTECTION How information about you will be used Personal information you share with us may be used in a number of ways To make decisions relating to an application for housing or other services we provide To carry out a reference or credit check To communicate with you about our services To manage and maintain your tenancy For statistical analysis When you give us someone else’s personal information in connection with your relationship with us on behalf of that person (such as a joint tenancy) you confirm that you have obtained their consent for this information to be disclosed to us and used as described within this Privacy Notice How information about you may be shared We may share your information with and obtain information from other organisations where relevant and appropriate to your relationship with us, this could include; Organisations linked to the Trust Homechoice housing application process, utility companies, local authorities, Government departments and other agencies to help manage and maintain your tenancy. We will also share information with maintenance contractors to assist them in carrying out repairs and maintenance in your property, where required to do so by law and in the recovery of outstanding debts. We will not sell your information to any organisations to be used for marketing purposes. Further Information If you require more information relating to Data Protection and how this affects you please visit our website at www.wvht.co.uk or contact us at the following address. Data Protection Officer Weaver Vale Housing Trust Limited Gadbrook Park Rudheath Northwich Cheshire CW9 7LL